Stereoelectroencephalography for Epilepsy Presurgical Assessment: A Nationwide Survey of Evolution of Practice in Australia.

IF 2.3 Q3 CLINICAL NEUROLOGY
Neurology. Clinical practice Pub Date : 2025-08-01 Epub Date: 2025-07-07 DOI:10.1212/CPJ.0000000000200512
Aileen McGonigal, Chong Wong, John S Archer, Armin Nikpour, Nicholas D Lawn, Andrew Neal, Wendyl Jude D'Souza
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引用次数: 0

Abstract

Background and objectives: Stereoelectroencephalography (SEEG) is increasingly used worldwide for epilepsy presurgical evaluation. A data-driven view of SEEG practice evolution is lacking for any world region. We aimed to perform a nationwide survey of SEEG use in Australian adult epilepsy centers. We predicted that the proportion of nonlesional MRI cases, number of electrodes, and radiofrequency thermocoagulation (RF-TC) use would increase over time.

Methods: All epilepsy centers in Australia undertaking SEEG in patients older than 16 years at any time were invited to participate in a nationwide survey. Data were retrospectively and/or prospectively collected on patient demographics and SEEG exploration. Descriptive statistics were used.

Results: A total of 281 SEEG explorations were performed in 8 centers from 2012 until 2023, 278 of which (99%) are reported here. A definite epileptogenic MRI lesion was present in 30.6% with no overall significant growth in the proportion of nonlesional cases (χ² [1, N = 278] = 0.067, p = 0.79), although this varied per center. Patients identifying as Indigenous Australians comprised 1.6% of this national SEEG survey vs an estimated national indigenous population of 3.8%. The median number of electrodes increased from 8 in 2012 to 15 in 2023. A total of 174 patients (62.6%) were offered resective surgery after SEEG. Surgery was performed with 1-year follow-up in 114, of whom 72.8% were seizure-free at the last follow-up. The presence/absence of an MRI lesion was not associated with postoperative seizure-free outcomes (χ² [1, N = 114] = 0.06, p = 0.80). RF-TC use differed between centers and evolved, with a crossover to the majority use of RF-TC occurring 5 years after regulatory approval.

Discussion: This comprehensive nationwide and regional survey of SEEG practice comprises full ascertainment of all centers and allows analysis of changes in practice over time. Whole cohort results show a high proportion of nonlesional MRI cases achieving satisfactory surgical outcomes and evolution to increased RF-TC use. Indigenous access to SEEG seems to be lower than expected, consistent with broader health care access issues for this population group. Nationwide collaboration on SEEG data provides a basis for analysis of practice at the individual center and state and national levels to optimize health care planning and sharing of expertise.

立体脑电图癫痫术前评估:在澳大利亚实践演变的全国调查。
背景和目的:立体脑电图(SEEG)在世界范围内越来越多地用于癫痫术前评估。任何世界地区都缺乏数据驱动的SEEG实践演变观点。我们的目的是对澳大利亚成人癫痫中心的SEEG使用情况进行全国性调查。我们预测,随着时间的推移,非病变MRI病例的比例、电极数量和射频热凝(RF-TC)的使用将会增加。方法:邀请澳大利亚所有在任何时间对16岁以上患者进行SEEG的癫痫中心参加一项全国性调查。回顾性和/或前瞻性收集患者人口统计学和SEEG探索的数据。采用描述性统计。结果:2012年至2023年,共在8个中心进行了281次SEEG探查,其中278例(99%)在本文中报道。30.6%的患者存在明确的癫痫性MRI病变,非病变病例的比例总体上没有显著增长(χ 2 [1, N = 278] = 0.067, p = 0.79),尽管这在每个中心都有所不同。在本次全国SEEG调查中,澳大利亚土著患者占1.6%,而全国土著人口估计占3.8%。电极的中位数从2012年的8个增加到2023年的15个。共有174例患者(62.6%)在SEEG术后接受了切除手术。114例患者术后随访1年,其中72.8%患者末次随访无癫痫发作。MRI病变的存在/不存在与术后无癫痫发作结果无关(χ 2 [1, N = 114] = 0.06, p = 0.80)。RF-TC的使用在不同的中心有所不同,并不断发展,在监管机构批准后5年,RF-TC的主要使用发生了交叉。讨论:对SEEG实践的全面的全国和区域调查包括对所有中心的充分确定,并允许分析实践随时间的变化。整个队列结果显示,高比例的非病变MRI病例获得满意的手术结果,并逐渐增加RF-TC的使用。土著居民获得SEEG的机会似乎低于预期,这与该人口群体获得更广泛的保健服务的问题一致。在SEEG数据方面的全国合作为分析各个中心、州和国家各级的实践提供了基础,以优化医疗保健规划和分享专门知识。
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来源期刊
Neurology. Clinical practice
Neurology. Clinical practice CLINICAL NEUROLOGY-
CiteScore
4.00
自引率
0.00%
发文量
77
期刊介绍: Neurology® Genetics is an online open access journal publishing peer-reviewed reports in the field of neurogenetics. The journal publishes original articles in all areas of neurogenetics including rare and common genetic variations, genotype-phenotype correlations, outlier phenotypes as a result of mutations in known disease genes, and genetic variations with a putative link to diseases. Articles include studies reporting on genetic disease risk, pharmacogenomics, and results of gene-based clinical trials (viral, ASO, etc.). Genetically engineered model systems are not a primary focus of Neurology® Genetics, but studies using model systems for treatment trials, including well-powered studies reporting negative results, are welcome.
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